David and Ginger Twitchell, practicing Christian Scientists, were convicted of involuntary manslaughter after their two-and-a-half-year-old son, Robyn, died from peritonitis caused by an obstructed and perforated bowel. The condition could have been corrected by surgery with a high likelihood of success. During Robyn's five-day illness, the Twitchells relied on prayer, a Christian Science practitioner, a Christian Science nurse, and advice associated with their church rather than obtaining medical treatment.
The evidence permitted the jury to find that Robyn was in substantial distress and that ordinary parents would have sought medical care in time to save him. It also permitted a finding that the parents' failure to obtain care was wanton or reckless, assuming they had a legal duty to do so and no legal protection for exclusive spiritual treatment.
Before Robyn died, David Twitchell read a church publication concerning Massachusetts Christian Scientists' legal rights and obligations. The publication quoted G. L. c. 273, § 1, which stated that a child was not neglected or lacking proper physical care solely because the child received remedial treatment by spiritual means from an accredited practitioner. The publication also repeated language from a 1975 Attorney General opinion suggesting that the statute precluded criminal liability of a negligent parent who withheld medical care for religious reasons.
At trial, the judge excluded the relevant church publication and did not instruct the jury on a defense based on reasonable reliance on an official interpretation of law. The defendants were convicted and received probationary sentences. They appealed, and the Supreme Judicial Court granted direct appellate review.
Issue #1
Whether Massachusetts common law imposes a parental duty to obtain medical care for a gravely ill child, such that a wanton or reckless omission can support involuntary-manslaughter liability.
Holding
Yes. A parent has a common-law duty to provide necessary medical care to a child, and a wanton or reckless breach of that duty may constitute involuntary manslaughter.
Reasoning
Involuntary manslaughter may rest on an omission only when the defendant had a legal duty to act. Although a criminal duty need not be limited to conduct that would create civil liability, Massachusetts law recognizes parents' enforceable duty to care for and support their children and permits the Commonwealth to intervene when necessary to protect a child's welfare.
Massachusetts homicide law had already recognized a parental duty of care. In Commonwealth v. Gallison, the court upheld a manslaughter conviction where a parent made no effort to obtain medical help despite knowing that her child was gravely ill. Gallison established that the duty to provide for a child's care and welfare includes obtaining medical assistance in appropriate circumstances.
Thus, apart from any statute, the Twitchells had a common-law duty to seek medical attention when Robyn's condition required it. If their intentional omission created a high degree of likelihood that substantial harm would result, the jury could find their conduct wanton or reckless and could convict them of involuntary manslaughter.
Issue #2
Whether the spiritual-treatment provision of G. L. c. 273, § 1 barred a prosecution for common-law involuntary manslaughter.
Holding
No. The provision did not immunize parents from manslaughter liability for wantonly or recklessly failing to obtain medical treatment for a child.
Reasoning
Section 1 appeared in a statutory scheme principally directed to child support, neglect, and parental care obligations. Its spiritual-treatment language provided that a child receiving spiritual treatment alone would not be deemed neglected or lacking proper physical care for purposes of that section. Nothing in the text, statutory history, or placement of the provision indicated a legislative purpose to alter the separate common law of homicide.
The statute addressed neglect and a willful failure to provide proper physical care. Involuntary manslaughter, by contrast, rests on wanton or reckless conduct. Wanton or reckless conduct is not ordinary negligence, and manslaughter does not require proof that a parent willfully intended the resulting harm. The statutory terms therefore did not reach the elements of common-law involuntary manslaughter.
Because the court could resolve the case through statutory construction, it did not decide the Commonwealth's argument that the spiritual-treatment provision was unconstitutional under the federal Establishment Clause or Equal Protection Clause.
Issue #3
Whether prosecuting the Twitchells for manslaughter denied them due process because the statutory spiritual-treatment provision failed to give fair warning of possible criminal liability.
Holding
No, not merely because of the statute. The court's construction of § 1 was not an unforeseeable expansion of criminal law, and the statute did not issue contradictory commands.
Reasoning
Due process requires fair warning of prohibited conduct. But § 1's limited protection against neglect or willful-failure charges did not reasonably communicate an all-purpose exemption from homicide liability. The provision said nothing about wanton or reckless conduct or about common-law manslaughter.
The court's interpretation was not the sort of unexpected, retroactive judicial enlargement of criminal liability prohibited by Bouie v. City of Columbia. It did not change a longstanding common-law rule; instead, it applied the established distinction between statutory neglect offenses and involuntary manslaughter.
Nor did the coexistence of § 1 and the manslaughter doctrine create legally contradictory commands. Parents relying on spiritual treatment had to assess the point at which their child's condition made their failure to seek medical care wanton or reckless. Due process permits criminal liability to turn on such factual matters of degree.
Issue #4
Whether the defendants were entitled to present an affirmative defense that they reasonably relied on an official interpretation of law suggesting that exclusive spiritual treatment would not result in criminal prosecution.
Holding
Yes. The defendants were entitled to have a jury consider a reasonable-reliance, or entrapment-by-estoppel, defense; the failure to present it created a substantial risk of a miscarriage of justice requiring reversal.
Reasoning
The 1975 Attorney General opinion stated that § 1 expressly precluded criminal liability of a negligent parent who failed to provide medical care because of religious beliefs, while also observing that courts could order services for children. Although the opinion focused on negligence rather than manslaughter, a reasonable layperson could read its broad language about an inability to prosecute parents as suggesting that no criminal prosecution would follow from reliance on spiritual treatment.
The Christian Science publication that David Twitchell read repeated the Attorney General opinion's key language without warning of potential manslaughter liability. The church publication apparently relied on the Attorney General's official view, and the defendants also consulted a church Committee on Publication representative. A jury could find that the defendants reasonably relied, indirectly but genuinely, on an official legal interpretation while attempting to comply with the law and practice their faith.
The Attorney General was the Commonwealth's chief legal officer and was acting within his official responsibilities when he issued the opinion. Whether the opinion reasonably appeared to authorize the defendants' conduct, and whether their reliance on the church publication and church advice was reasonable, were factual questions for the jury. The defendants bore the burden of proving the defense by a preponderance of the evidence.
Defense counsel did not request this instruction, and the trial judge therefore was not faulted for failing to give it. Still, the defendants' evident effort to care for their child within what they understood to be legal limits, together with the excluded church publication and the potentially misleading Attorney General opinion, meant that omission of the defense could have affected the verdict. The court therefore reversed the convictions, set aside the verdicts, and remanded for a possible new trial.